Download NR511 Clinical Evaluation Assignment (CEA): Study Guide with Sample Cases and more Exams Nursing in PDF only on Docsity!
NR511 Clinical Evaluation Assignment
(CEA): Study Guide with Sample Cases
Treatment of type 1 hypersensitivity reaction may include all but which of the following? A - Epinephrine (Epi-Pen) B - Prednisone (Deltasone) C - All of these may be used to treat type 1 hypersensitivity reactions D - Diphenhydramine (Benadryl) - Correct Answer: C - All of these may be used to treat type 1 hypersensitivity reactions Patients with acute autoimmune disorder flares are routinely treated with medications to reduce the inflammation, but does not typically manage the underlying disease state. Which class of medication is typically used to manage the underlying long- term disease state with most autoimmune disorders? A - H2 receptor antagonists B - Non-steroidal anti-inflammatories C - Corticosteroids D - Monoclonal antibodies - Correct Answer: D - Monoclonal antibodies Kyle, a 21 year old college student, presents with persistent itching and hives (urticaria) scattered on his torso and upper arms this morning. This is the first episode of this, and there is no evidence of wheezing, stridor, perioral swelling, or dysphonia. His vital signs are 120/72, HR 84, R 16, Temp 98.5 .F You anticipate his symptoms of urticaria to be reasonably well managed with which of the following class of medications? A - Angiotensin Converting Enzyme Inhibitors B - NSAIDs C - Inhaled corticosteroids D - First generation antihistamines - Correct Answer: D - First generation antihistamines
Karen, a 49 year old caucasian female with pale skin and history of easy freckling after sun exposure presents to your clinic for evaluation and skin survey. You notice a patchy area of lesions from sun exposure and notice presence of telangiectasia on the lesions. Which of the following agents would you be likely to be successful in your treatment of this common skin lesion? A - Salycilic Acid solution topically B - Prednisone (Deltasone) orally C - Fluororuacil (5-FU) cream D - Isotretinoin (Accutane) orally - Correct Answer: C - Fluororuacil (5-FU) cream You have the pleasure of working at the health clinic at a summer resort as a nurse practitioner. Benny, a 19 year old male presents with first degree burns over their anterior torso after being out in the sun too long without any protection while taking a medication prone to photosensitivity reactions. To accurately document his burn surface area, you use the rule of palms. In evaluation of a patient's body surface area (BSA) using the rule of palms, which portion of the patient's body surface area is covered by the patient's palm? A - 3%. B - 2%. C - 1%. D - 4%. - Correct Answer: C - 1%. Your patient Katie, a 24 year old female patient presents to your clinic with erythema on her face that does not cross the bridge of the nose and seems to flare up with exercise and certain foods. She says she feels like her skin is flushed at times and is self-conscious. Which of the following agents is most appropriate to use for chronic treatment of this condition? A - Cefuroxime (Ceftin) B - Amoxicillin (Amoxil) C - Doxycycline (Vibramycin) D - Niacin extended release (Niacin) - Correct Answer: C - Doxycycline (Vibramycin)
Classic phase 2 migraine is managed by the use of which general principle? A - Patients in phase 2 migraine should avoid any additional serotonin for risk of serotonin syndrome B - Patients in phase 2 migraine need serotonin antagonism C - Patients in phase 2 migraine need serotonin agonism D - Patients in phase 2 migraine will benefit from oxygen therapy - Correct Answer: C - Patients in phase 2 migraine need serotonin agonism Firm contraindication for the use of combined oral contraceptives (both estrogen and progesterone) include which of the following patient findings? A - Remote history of provoked DVT after a knee surgery B - History of cluster headaches C - History of migraine without aura D - History of migraine with aura - Correct Answer: D - History of migraine with aura Your nurse practitioner student asks you to help him clarify the different types of diuresis. As an example, you present the question to him that the use of Ted stockings for patients with lower extremity edema is an example of which type of diuresis? A - Constrictive diuresis B - Osmotic diuresis C-Loop diuresis D - Pressure diuresis - Correct Answer: Which of the following agents will have the effect of constricting the afferent arteriole of administration? A - Furosemide (Lasix) B - Valsartan (Diovan) C - Misoprostol (Cytotec) D - Ibuprofen (Advil) - Correct Answer: D - Ibuprofen (Advil)
The hypertensive adult male patient aged 55 years has been initiated on lisinopril (Privinil) for two consecutive in-clinic blood pressure readings over 140/90. As you provide the patient with medication education, which of the following levels should the patient be aware of may elevate and become potentially life threatening if untreated? A - BNP B - Calcium C - Pro-BNP D - Potassium - Correct Answer: D - Potassium Decreased reflexes, worsening of the confusional state and sleepiness, bladder paralysis, flushing, headache, and constipation are al evidence of toxic levels of which of the following? A - Azithromycin (Zithromax) B - Magnesium C - Oxymetazoline (Afrin) D - Digitalis glycosides (Digoxin) - Correct Answer: B - Magnesium Your 22 year old male patient states during his review of systems thathis scrotum is very enlarged and feels like it is full a powerlifter and works as a trash collector. You suspect the patient likely has which of the following diagnoses? A - Varicocele B - Meningocele C - Rectocele D - Hydrocele - Correct Answer: A - Varicocele The point of maximum impulse (PMI) is MOST often palpable in healthy adults when positioned in the supine or left lateral decubitus position. Which one of the following locations is most commonly described as the PMI in a healthy adult? A - Left 2nd intercostal space, midaxillary line B - Left 5th intercostal space, midclavicular line C - Right 4th intercostal space, midaxillary line
A - Renal function panel B - Urinalysis C - Non-dilated eye exam D - All of these are appropriate options - Correct Answer: D - All of these are appropriate options During your visit with a 19 year old patient for a college health physical, your health history includes a diagnosis of angioedema. What of the following parts of the body are were likely involved? A - Isolated to the colon B - Anywhere in the enteral tract C - Chest D - Face and Lips - Correct Answer: D - Face and Lips Which of the following dermatologic lesions is precancerous and likely due to prolonged exposure to UV-B? A - Actinic Keratosis B - Basal cell carcinoma C - Verucca D - Seborrheic dermatitis - Correct Answer: A - Actinic Keratosis Based on your evaluation of ABCDE for melanoma, which of the following represents a suspicous finding? A - Irregular borders B - Symmetrical nature C - Brown color D - Diameter of 0.4 cm - Correct Answer: A - Irregular borders Your patient is complaining of hypersomnia, lack of motivation, weight gain, and anhedonia. Suspecting a diagnosis of clinical depression, you anticipate the patient will benefit from treating their underlying deficit of which of the following neurotransmitters?
A - GABA
B - Serotonin C - Dobutamine D - Glutamate - Correct Answer: B - Serotonin As a prudent nurse practitioner, the diabetic, hypertensive patient you are seeing should be evaluated for early evidence of renal damage from both diabetes and hypertension. Which of the following assessment tools should the nurse practitioner order first for the evaluation of early renal dysfunction secondary to diabetes or hypertension? A - BUN/creatinine ratio B - Urinalysis with micro/macro albumin C - Renal biopsy D - Urine sodium - Correct Answer: B - Urinalysis with micro/macro albumin While evaluating a patient in your clinic for a routine health visit, you auscultate crackles in the poster left lower lobe, have the patient cough, with follow-up auscultation revealing clear breath sounds. Which one of the following would you suspect? A - Congestive heart failure B - Atelectasis C - Laryngospasm D - Bronchiactasis. - Correct Answer: B - Atelectasis Your 39 year old patient who has recently been hospitalized for an appendectomy and is being seen in your clinic for post-operative follow-up with primary care. On assessment, the patient complains of some incisional pain and otherwise examination is normal, with the exception of dull percussion sounds noted on the thorax over lung tissue. Which of the following diagnoses would be explained by this finding in post-operative patient? A - Left-sided heart failure B - Chronic bronchitis C - Atelectasis D - Healthy patient with no coexising disease - Correct Answer: C - Atelectasis
The nurse practitioner is caring for a patient with an elevated WBC, fever, chills, and malaise. When developing a differential diagnosis for this finding, which of the following is not a potential cause of the elevated WBC? A - Sepsis B - Diabetes Mellitus Type 2 C - Leukemia D - Recent oral corticosteroid therapy - Correct Answer: B - Diabetes Mellitus Type 2 Your 21 year old sexually active female patient states during a routine health exam that they have some "weird bumps" on their vulva.She is concerned she has a sexually transmitted infection. You notify her that condyloma are caused by exposure to which of the following? A - Chlamydia B - Herpes zoster C - Human papilomavirus type 6 and 1 D - Parvovirus B19 - Correct Answer: C - Human papilomavirus type 6 and 1 Yourpatient who has underwent a recent major medical medical procedure is at a rehabilitation center and is having a hard time being motivated to do therapy. When you interview them as the nurse practitioner on staff for the subacute rehab center, they appeardespondent, and are having a hard time being wakeful during therapy sessions. They have stable vital signs, temperature, urine output, and are not ill-appearing. As a prudent nurse practitioner, you understand this may represent which of the following? A - Cushing syndrome B - Situation depression C - Addison's disease D - Untreated anxiety - Correct Answer: B - Situation depression The 18 year old female patient who inappropriately exhibits fear of abandonment, intense interpersonal relationships, affective instability, and recurrent self-harm describes which of the following diagnoses: A - Borderline personality disorder B - Seasonal affective disorder
C - Reactive attachment disorder D - Bipolar disorder - Correct Answer: A - Borderline personality disorder You are treating a patient who has stopped taking their diuretic regimen against medical advice while they are on vacation since it made them urinate too frequently for their plans. Now they are 21 pounds heavier than their baseline weight, have respiratory crackles in bilateral bases, and have severe generalized lower extremity and truncal edema extending to the sacrum and abdomen. On your documentation, this is referred to as which of the following conditions? A - Nephrotic syndrome B - Syndrome of inappropriate antidiuretic hormone (SAIDH) C - Ascites D - Anasarca - Correct Answer: D - Anasarca The 84 year old lethargic patient who lives alone accidentally overdosed their amlodipine (Norvasc) was found by their daughter and taken to your clinic for evaluation. On exam, you found her blood pressure of 80/42 which the daughter says was "about what she found on her home cuff for the last 6 hours before bringing her in to be evaluated". The patient was then transferred to the hospital for evaluation. During her hospitalization she was also evaluated with CBC, BMP, and a UA. The results reflect normal labs except the UA showed trace WBCs in urine and no leukocyte esterases or nitrites and the BMP showed a creatinine of 1.9 with her normal baseline of1.2 (normal range 0.5-1.2mg/dL) and BUN of 34, with a baseline of 20 (normal range 10-20 mg/dL). What si likely to cause which of her renal issues? A - Pyelonephritis B - Chronic kidney disease C - Acute tubular necrosis D - Glomerulonephritis - Correct Answer: C - Acute tubular necrosis Your 52 year old male patient Gus has a diagnosis of heart failure with a low ejection fraction (HFrEF) (EF 30%) following a recent myocardial infarction and has been started on optimal medical therapy. Assuming he tolerates all the following medicines without side effects or contraindications, which one of the following agents should be avoided for optimal medical therapy specifically aimed at optimizing his HFrEF? A - Amlodipine (Norvasc) B - Entresto (Sacubitril/Valsartan)
Zeke, a 2 year old male patient presented to your primary care clinic with unilateral leg swelling and tenderness after an "al nighter"playing video games. You suspect he has a provokedDVT from immobility and an ultrasound has been ordered. While awaiting thisexam to be performed, you preemptively discuss anticoagulation with the patient assuming he wil most likely be needing this therapy. Which of the following represents adequate understanding from the patient? A - The goal for my INR on rivaroxaban (Xarelto) should be somewhere over 20 B - Regardless of the venous doppler findings, I can start warfarin(Coumadin) alone an it will take around 4-5 days to get the drug to properly anticoagulate me C - If they find a blood clot, I will need to use enoxaparin (Lovenox) in addition to warfarin (Coumadin) until my INR is over 2. D - I will need to take enoxaparin (Lovenox) ifIma started on rivaroxaban Xarelto) - Correct Answer: C - If they find a blood clot, I will need to use enoxaparin (Lovenox) in addition to warfarin (Coumadin) until my INR is over 2. Which of the following are common causes of a provoked deep vein thrombosis (DVT)? A - Cancer B - Factor V Leiden C - Protein C or S deficiency D - All of these are common causes of provoked DVT - Correct Answer: D - All of these are common causes of provoked DVT In discussing a new diagnosis of human immunodeficiency virus (HIV) for your patient, the patient demonstrates good understanding of the possible agents which may be used to include which of the following: A - All of these may be used to manage my disease B - Protease inhibitors C - Nucleoside reverse transcriptase inhibitors D - Non-nucleotide reverse transcriptase inhibitors - Correct Answer: A - All of these may be used to manage my disease Which class of medications are indicated as first line management of both post-traumatic stress disorder (PTSD) and major depressive disorder? A - Selective serotonin reuptake inhibitors
B - Non-selective dopamine reuptake inhibitors C - Mood stabilizers D - Monoamine oxidase inhibitors. - Correct Answer: A - Selective serotonin reuptake inhibitors Dave, a 41 year old software engineer presents to your clinic with complaints of back spasms after being forced to return to their office instead of working from home. He believes the chair at his desk is the culprit and his causing him severe back spasms secondary to anaggravated old sports injury. nI addition to non-pharmacologic solutions, which of the following represents an agent appropriate for the managementof his spasms? A - Prednisone (Deltasone) B - Methy naltrexone (Relistor) C - Gabapentin (Neurontin) D - Cyclobenzaprine (amirx) - Correct Answer: D - Cyclobenzaprine (amirx) Which of the following concepts refers to where small differences in dose or blood concentration may lead to serious therapeutic failures and/or adverse drug reactions that are life-threatening or result in persistent or significant disability or incapacity? A - Narrow therapeutic index B - Wide therapeutic index C - Post-antibiotic effect D - Zero order kinetics - Correct Answer: A - Narrow therapeutic index Which of the following agents will have the effect of dilating the efferent arteriole of the kidney and thereby reducing elimination of creatinine during administration? A - Valsartan (Diovan) B - Misoprostol (Cytotec) C - Furosemide (Lasix) D - Ibuprofen (advil) - Correct Answer: D - Ibuprofen (advil)
D - Acanthuses nigricans - Correct Answer: D - Acanthuses nigricans The determination of topical corticosteroid potency is largely based on the unique drug as well as which of the following variables? A - Vehicle of delivery (cream, lotion, elixir, etc) B - None of these are correct C - Duration of use (once, continuous, etc) D - Site of use (back, face, arms, etc) - Correct Answer: A - Vehicle of delivery (cream, lotion, elixir, etc) The most commonly described non-life threatening side effect of HmgCo-A reductase inhibitor therapy is which of the following? A - Tachycardia B - Myalgia C - Rhabdomyolysis D - Airway swelling - Correct Answer: B - Myalgia During a post-hospital discharge visit, you notice your 71 year old female patient has been diagnosed with a "new murmur" found by the hospitalist during their recent hospitalization for CHF exacerbation. In evaluating the patient, during which phase of the cardiac cycle would you anticipate auscultation of a S3 or S4 heart sound? A - Diastole B - S3 in systole while S4 in diastole C - Systole D - S4 in diastole while S3 in systole - Correct Answer: A - Diastole The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where would the S1 heart sounds correlate with the electrocardiographic waves? A - At the end of the T wave B - At the start of the T wave C - Peak of the R wave
D - At the start of the P wave - Correct Answer: C - Peak of the R wave Michael, a 72 year old male patient who previously presented with stable cardiac-type chest pain has underwent a stress test. He presents today to review the stress test results, which show EKG findings of ST segment depression during the exam in leads V3 and V4 as well as some concurrent chest discomfort. Based on these findings, which of the following are NOT priority medical decisions? A - Prescribe metoprolol (Lopressor) 12.5mg PO BID B - Prescribe aspirin 81mg PO daily C - Refer to cardiology for angiography D - Check for thyroid dysfunction - Correct Answer: D - Check for thyroid dysfunction While examining a 53 year old female patient, you auscultate abnormal breath sounds over all fields, and now assess transmission of voice sounds by having the patient say "ee" while auscultating the chest with the diaphragm of your stethoscope. Normally, you should auscultate a muffled "e" sound, however, you hear hear a nasally "a" sound. Which one of the following will you document is present? A - Positive stereognosis B - Positive for egophony C - Negative for bronchophony D - Negative for egophony - Correct Answer: B - Positive for egophony While assessing the 19 year old patient for a new onset cough, the nurse practitioner may inspect, auscultate, palpate, and/or percuss.How does performing percussion of the thorax assist the provider during the physical examination? A - To assist with the confirmation of cardiac origin of angina B - To assess for deep-seated lesion and tumors C - To assess for any pain or discomfort prior to palpitation of the chest wall D - To identify if underlying tissue are air-filled, fluid-filled or consolidated - Correct Answer: D - To identify if underlying tissue are air-filled, fluid-filled or consolidated Your 42 year old male patient has been referred to your clinic for establishing care and on his intake survey, you note he has documented diagnosis of interstitial lung disease. You
Your 32 year old female patient presented for a routine health exam states they have a diagnoses of hyperthyroidism by anotherprovider a year ago. In addition to evaluation with TSH and T4 labwork, which of the following represent typical signs of hyperthyroidism expected on your exam of this patient? A - Hypersomnia B - Tachycardia C - Lethargy D - Recent unplanned weight gain - Correct Answer: B - Tachycardia Your patient with a diagnosis of autoimmune hepatitis is being seen in your clinic for routine liver serology and follow-up examination. Which of the following correctly identifies the normal liver span when percussing the liver of a HEALTHY adult? A - 6 - 12 cm in the midsternal line B - 4 - 8 in the left midclavicular line C - 4 - 8 cm in the right midclavicular line D - 6 - 12 cm in the right midclavicular line - Correct Answer: D - 6 - 12 cm in the right midclavicular line The 33 year old male patient presents with complaints of abdominal pain after a recent birthday party where other guests alsosuspected food borne illness and gastroenteritis. To elicit the most accurate evaluation of this patient, which is the order of assessment which should be done for the abdomen? A - Inspection, auscultation, palpation, percussion B - Inspection, auscultation, percussion, palpation C - Percussion, auscultation, palpation, inspection D - Auscultation, palpation, percussion, inspection - Correct Answer: A - Inspection, auscultation, palpation, percussion The 19 year old male patient presents with acute symptoms of abdominal pain and a history of intermittent heartburn and spicy food intolerance, as well as anxiety due to his college athletic performance. You have a concern the patient may have a perforated gastric ulcer and is experiencing peritonitis. Which of the following exam findings is NOT supportive of this diagnosis? A - Guarding
B - Rebound tenderness C - Absence of pain with withdrawal of palpation D - Rigidity - Correct Answer: C - Absence of pain with withdrawal of palpation Your 22 year old female patient is seeing you for complaints of sinus pressure and congestion. Which one of the following sinuses should be palpated during your examination? A - Mandibular B - Ethmoid C - Sphenoid D - Frontal - Correct Answer: D - Frontal Your 49 year old male patient presents with weight loss, night sweats, anhedonia, and a CXR showing profoundly enlarged hilar adenopathy. Based on these findings, a diagnosis of lymphoma would be in your working differential. Which one of the following assessment findings when palpating lymph nodes would be INCONSISTENT with this diagnosis? A - Hard nodes B - Fixed nodes C- Stationary or not moveable with palpation D - Non-tender, minimally palpable anterior cervical chain node palpation - Correct Answer: D - Non-tender, minimally palpable anterior cervical chain node palpation Your new patient intake history of an elderly man includes a history of Ehlers-Danlos with complications of retinal detachment treated with gas pneumopexy. In discussing this history, you recall the transparent mass of gelatinous material where the gas pneumopexy is performed can be found in which chamber(s) of the eye? A - None of the above; it's only seen as an abnormal finding with malignancy B - Anterior only C - Posterior only D - Both but greater in the anterior chamber - Correct Answer: B - Anterior only
